BIOBALANCE Inc.
Informed consent
Disclosure: I am fully aware that the biofeedback therapist is not a medical doctor, chiropractor, dentist, veterinarian, psychotherapist or mental health counselor. I understand that they do not diagnose, analyze, assess, evaluate, treat, medicate, cure, or prevent any medical, dental, chiropractic, veterinary, psychological or mental health condition, disorder or disease.
Biofeedback Training Outcomes: Biofeedback is not a substitute for effective standard medical, dental, chiropractic or psychotherapy treatment or veterinary treatment for your pet. I understand that I am advised to continue ongoing medical treatment and therapies until otherwise advised by my psychotherapist, physician or medical practitioner. If I am taking medications, I understand that I am advised, and aware that it is important to stay in close communication with my physician. I understand that the biofeedback therapist does not recommend to reduce or stop taking any medications from the outcome of my biofeedback training without discussing it with my physician first. It is my responsibility to monitor the effects of biofeedback training and to continue the training as long as it is beneficial to me. I understand that research suggests that while most people gain considerable benefits from biofeedback training, some people may not gain any benefit at all. I also understand that the biofeedback session is only for stress detection and stress reduction. I further understand it is my responsibility to ask my medical doctor for permission to undergo biofeedback training if I wear a pacemaker, or I am pregnant or have a seizure disorder or any medical condition that may be exacerbated by biofeedback or relaxation.
Side effects of Biofeedback: I understand that the biofeedback equipment is registered with the FDA. It is generally considered safe, but it is possible that biofeedback may exacerbate some emotional problems, at least temporarily, during the biofeedback training sessions. Some clients may become drowsy. Other potentially harmful side effects not yet reported may occur. I agree to advise the biofeedback therapist anytime I feel any side effects, so corrective steps may be taken to alleviate my discomfort.
Confidentiality: I understand that my identity and any information about me, whether I share it with you or you discover it on your own, will be held in the strictest confidence, except when released by me or specifically required by law. I have the right to waive this confidentiality agreement in whole or part at any time.
Acknowledgment: By signing below, I acknowledge that I have read and understand this document, and have received acceptable answers to all of my questions about the services, and consent to receiving biofeedback training. I warrant I am not under duress at this time and my consent is given voluntarily and without coercion. I understand that I may discontinue biofeedback training at any time and may refuse to participate in any particular or specific biofeedback training without penalty.
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